Clinical and health economic evaluation of a post-stroke arrhythmia monitoring service

Muggeridge, David; Callum, Kara; Macpherson, Lynsey; Howard, Nick; Graune, Claudia; Megson, Ian; Giangreco, Adam; Gallacher, Susan; Campbell, Linda; Williams, Gethin; Macaden, Ashish; Leslie, Stephen J.

Abstract

Atrial fibrillation (AF) is a major cause of recurrent stroke and transient ischaemic attack (TIA) in the UK. As many patients can have asymptomatic paroxysmal AF, prolonged arrhythmia monitoring is advised in selected patients following a stroke or TIA. This service evaluation assessed the clinical and potential health economic impact of prolonged arrhythmia monitoring post-stroke using R-TEST monitoring devices.

This was a prospective, case-controlled, service evaluation in a single health board in the North of Scotland. Patients were included if they had a recent stroke or TIA, were in sinus rhythm, and did not have another indication for, or contraindication to, oral anticoagulation. A health economic model was developed to estimate the clinical and economic value delivered by the R-TEST monitoring. Approval to use anonymised patient data in this service evaluation was obtained.

During the evaluation period, 100 consecutive patients were included. The average age was 70 ± 11 years, 46% were female. Stroke was the presenting complaint in 83% of patients with the other 17% having had a TIA. AF was detected in seven of 83 (8.4%) patients who had had a stroke and one of 17 (5.9%) patients with a TIA. Health economic modelling predicted that adoption of R-TEST monitoring has a high probability of demonstrating both clinical and economic benefits.

In conclusion, developing a post-stroke arrhythmia monitoring service using R-TEST devices is feasible, effective at detecting AF, and represents a probable clinical and economic benefit

• Journal Article Type: Article
• Acceptance Date: Feb 7, 2022
• Online Publication Date: May 31, 2022
• Publication Date: May 31, 2022
• Deposit Date: Jun 3, 2022
• Publicly Available Date: Jun 27, 2022
• Journal: The British Journal of Cardiology
• Print ISSN: 0969-6113
• Peer Reviewed: Peer Reviewed
• Volume: 29
• Issue: 2
• Pages: 46-51
• DOI: https://doi.org/10.5837/bjc.2022.015
• Public URL: http://researchrepository.napier.ac.uk/Output/2875681
• Publisher URL: https://bjcardio.co.uk/2022/05/clinical-and-health-economic-evaluation-of-a-post-stroke-arrhythmia-monitoring-service/